Dr. James M. Carmichael, DC is a 1967 Graduate of Springfield's Drury University and a Graduate of the St. Louis based Logan University's College of Chiropractic, in 1970. Dr. Carmichael's education and credentials also include Diplomate status conferred by the National Board of Chiropractic Examiners, State Board licensed to perform acupuncture, State Board licensed Insurance and Claims Review Consultant and, for many years, an active United States Department of Transportation Certified Medical Examiner. A long time resident of Springfield, the doctor has devoted his life and career to the art of healing the injured with safe, natural, conservative treatment that yields relief of pain and restored function. Dr. Carmichael has the distinction of being Springfield's most senior Chiropractic Physician, being in active practice more years than any other Springfield Doctor of Chiropractic.
As a point of family history, the doctor is of Scottish Ancestry with his 7th generation fore bearers having emigrated to America from Scotland around the year 1800. The doctors father, Dr. Bruce Carmichael, was also a Chiropractic Physician who practiced in Lebanon Missouri for nearly fifty years. The elder doctor was also a decorated Navy pilot during World War II and saw action over the beaches at Normandy France on D-Day. Dr. Bruce was also a gifted writer having authored, produced and directed two motion picture scripts, a book of children's stories titled "Little Path by Shadow Mountain" and his writings are featured in the first two issues of the popular book series "Chicken Soup For The Soul". The doctor's mother, Mildred, was an accomplished artist and art instructor in the Waynesville, Missouri school system for many years.
As we tell patients, whenever there is pain, symptoms or dysfunction in the body... there is always a "reason" and unless treatment is doing something about the "why" of the problem it's only covering up the outward symptoms and not really fixing the cause. So, our first job, with any patient, is to figure out the actual true underlying cause of their pain or symptoms. Since, our facility specializes in the treatment of auto accident injuries, we know that the problem was caused by an accident, but the question is... what were the consequences of that accident. What tissue was injured, what is the nature of the injury and what are possible treatment options?
The beginning point, with any patient, is to gather basic demographic information followed by a preliminary consultation. If findings indicate a condition not within the scope of services we provide, a referral recommendation is in order. Beyond this, the first step is known as the "history of the present illness": what are the specific pains and symptoms, where does it hurt, how intense is it, when and how did it begin, what makes it better or worse. Has there been any self care, such as OTC pain meds or prior professional care, such as an ER visit. Is the patient taking any prescribed medication. Naturally, other questions will follow.
Next comes the past medical history that will include such things as making note of any prior injuries, fractures, surgeries, as well as any known allergies or history of significant conditions such as high blood pressure or diabetes since these things may have affect the healing capacity of the body. If there has been an ER visit the past medical history will also include a review of those findings. Of special importance is knowing about any past auto accidents. Why? All of these bits of information are important for two main reasons. First, to lay a solid foundation for a proper assessment of the patient's present injuries. But, second is this: while most cases involving third party liability do not have to go to court and are settled by negotiation, it is important that each step, from the very beginning, is made in preparation for the possibility of that case winding up in front of a jury.
If a case actually does go to court... it's tooth and toenail... it's a dog fight and the defendants attorneys will try to make the injury victim look like a gold digger and their doctor look like an idiot. One of the best ways to stay out of court is to be fully prepared; to be ready, willing and able to step into the ring and duke it out. I have given live testimony at trial before and I will not shy away when the call comes again. With 50 years of experience and thousands of successful cases behind me I would be happy to look the defense attorney straight in eye and tell the court the truth of my patient's injuries.
With these thoughts in mind, a patient should make certain that the doctor knows about all relevant past history because, the last thing a victim wants in the courtroom is for the doctor to be surprised, on with witness stand, with the revelation of a string of past injuries, that the defense will then assert to be the cause of the victim's present claim. Because, that's the exact point where the victim's case collapses. If the defense tries to blame past injuries, the victim wants the doctor to be able to provide sworn testimony and state: "yes, I knew all about that and took that into consideration when I made my diagnosis of the victim's injuries".
Also, a part of the patient history is a "review of systems" to determine if any other conditions are involved. Following this is an entrance examination, generally known as a "physical, orthopedic, neurological examination". In this phase of new patient induction various observations and measurements will be made that will include such things as height, weight, blood pressure, pulse rate, oxygen level, respiration, reflexes, ranges of motion of the affected area, various orthopedic tests and close examination and palpation of affected joints and muscles. In some cases lab tests , such as urinalysis, may be indicated.
Since virtually all auto accidents involve some sort of physical trauma, special imaging can be expected as part of the workup. X-ray examination will help rule out possible fractures or dislocations as well as show the condition and alignment of the bony structures. A major target of injury in auto accidents is the spine. One of the reasons for this is the spine (sometimes referred to as the "central organ of posture") is, essentially, the anchoring point for all other body parts. The head is attached at one end, the pelvis and lower extremities at the other. The spine is the anchoring structure for the shoulder girdle and ribs, as well. Everything hooks on to the spine. When one takes into consideration that the spine also houses and protects the spinal cord and nerve roots (that influence all body functions) it is more than of just a little importance that the spine stays strong, healthy and well aligned.
While required less frequently, in some select cases advanced imaging, such as MRI or CT Scan may be needed to evaluate possible damage, such as ruptured discs or nerve compression syndromes.
Once all of this information has been obtained we are in a position to give careful evaluation of the case at hand and provide our medical opinion concerning the victim's injuries.
The final capstone of a new patient admission to treatment is sometimes referred to as a "report of findings". A new patient has questions and it is critical that they receive answers that help them understand the cause of their pain and symptoms, what treatment options are available as well as reasonable expectations concerning the course and outcome of recommended treatment.
The process of dealing with a significant injury and obtaining the desired outcome is a little bit like going on a journey. It takes time and effort to get from point A to point B and staying on track is vital to getting there. Patients are advised to keep all appointments and follow recommendations. Again, this is a two fold situation. First, if recommended treatment is needed to improve injuries, how does missing appointments help? Answer: it doesn't. Second, remember that business about settling claims by negotiation. One of the most damaging things an injury victim can do is have a pattern of missed appointments... "Ladies and Gentlemen of the Jury, in the defense of our accused client we submit to you that if this so-called injury victim was in fact injured and in pain the medical records we now show you would not clearly document all of these missed appointments..." We can practically see the Jury nodding in agreement. Case closed.
So... what to do? Take the getting well process seriously, stay on track, follow all recommendations and keep all appointments.
At CARMICHAEL AUTO ACCIDENT REHAB our practice is specifically devoted to the diagnosis, treatment and medico-legal documentation of auto accident and personal injury cases.
When an auto accident happens, an innocent victim is suddenly, in a fraction of a second, thrust from an ordinary day into a catastrophic, potentially life changing, nightmare and faced with having to find their way through uncharted territory: who to see, where to go, what to do, how to find needed help. These situations can and do turn whole families upside-down and helping those in the midst of all the turmoil and disruption that follows gives us a great deal of satisfaction and a positive meaning to our existence. In times of crisis, effective help is a good ally and our goal is to be the helping hand coming to the rescue.
Because, when accidents happen there is often a cascade of consequences to the victim including such stresses as loss of work, loss of a pay check and loss of transportation. When the stress of unexpected medical expenses is added to an already burdened budget it may force the victim to accept an unfair settlement to close their claim and, if that happens, everybody loses. The patient loses, their family loses and, because of likely future health problems, society at large may wind up shouldering the burden. The time to get well is NOW. So, lets help make it happen by removing one of the biggest barriers to getting needed help. Lets remove the barrier of costly medical expenses. Our goal is to create a stable safe environment where our patients can focus on getting well, rather than having to worry about financial obligations caused by no fault of their own. When we accept an injury victim for care, we do so with the intent of seeing our patient all the way to maximum medical improvement available through our care.
Injury victims commonly suffer neuro-musculoskeletal related signs and symptoms. These include headache, neck pain, shoulder/arm/hand pain or numbness, mid back pain, rib or chest pain, low back pain and/or pain into the pelvis, legs, knees or feet. There may be other symptoms as well, such as nausea, dizziness, ringing in the ears, changes in gastric, abdominal, kidney or bowel function. Painful symptoms also often interrupt restful sleep with waking multiple times per night. Adequate rest is important to speed the healing process.
That, of course, depends on the nature of the injury. Acute traumatic injuries can certainly involve fractures, dislocations or lacerations that require surgical care. However, having said that, one of the most common injuries resulting from auto accidents is damage to muscles, ligaments and joints wherein there is a partial, incomplete or micro tearing of the injured tissues known a "sprain injury". While it is possible for muscle or ligament tissue to be completely disrupted/ torn in two, the injury is more often a "partial" or "micro" tear of a muscle or ligament. If there was a total disruption of the injured tissue there would be an obvious loss of function of the affected part, such as the inability to stand or move the arms or legs.
However, with "partial" or "incomplete" tissue destruction, some measure of body function remains and because of that patients often underestimate the seriousness or extent of their injuries, believing that they are just "sore" and "it will go away". The problem here is that if sprain damage has occurred the body begins to respond to that injury immediately and if treatment is delayed it will heal in a damaged state. A similar example would be a broken bone. Only the body can "heal" the fracture, but the body can't "set" the fracture, and it a misaligned fracture is allowed to heal without treatment it will be misaligned permanently. Something similar occurs with sprain injuries. Specific treatment is needed to bring about effective healing.
A given muscle or ligament, while being identified as one specific structure, is in reality simply the coordination of multiple smaller elements. For example, think of a sleeve on a shirt. It's one "thing"... a sleeve, right? But, what is it really? It's a whole bunch of "little things"... the individual threads combined together to form the fabric. Now, imagine a piece of cloth that had been "over stretched".... not torn in two, but "over stretched". While the entire cloth wasn't destroyed, careful inspection would show that "some" of the threads in the fabric had been completely torn / destroyed. This is, more or less, what a "sprain" is for a muscle or ligament. Studies have shown that a rear end auto collision accident of only 10-12 MPH resulting in neck injuries, commonly known as "whiplash" may cause the destruction / loss of as much as 10-15% of the affected tissue fibers.
Since these fibers are responsible for moving you and holding you together, their injury will likely result in more than just the pain. The affected body part will most certainly be in some state of impaired function or misalignment. Effective treatment is directed at more than just relieving pain. Restoring function and correcting misalignment is critical to your present and future good health.
While there is value in all healing modalities, whether it's medication, surgery, physical therapy or massage therapy, to cite a few examples, what's known as CMT (chiropractic manipulative therapy) is a very good choice for injuries of this type. Why? Because chiropractic care is well suited to restoring function / mobility and alignment in an "acute" (fresh/recent) injury. If an injury has been allowed to heal in a disadvantaged condition or without early treatment, physical therapy may be a good choice to regain strength and mobility. Just as no thinking person would delay the setting of a broken bone, effective treatment for sprain injuries should begin without delay.
One of the most important reasons for prompt Chiropractic treatment is to reduce to adverse effect of scar tissue. When an individual muscle or ligament fiber has been destroyed, it isn't replaced by a new one. When it's gone... it's gone forever. But, yet, it gets replaced by something, but what? Well, what happens is that fibroblasts move to the area and begin to lay down collegen fibers that eventually forms the connective tissue matrix commonly known as "scar tissue" and, once formed, scar tissue is there permanently. Prompt chiropractic treatment helps improve the collegen fiber alignment and reduces the formation of microadhesions with the result that, when finally healed, there will be less stiffness, a better alignment, a better range of motion and more freedom of movement of the affected structures. And, since "life is motion"... that's a good thing.
One of the most frequent sites of scar tissue damage involves the joint capsule stabilizing each pair of vertebrae in the spine. Since there are 24 vertebrae in the spine, there are many possible sites of injury. Damage at the spine can cause a condition known as VSC (vertebral subluxation complex) and, chiropractic physicians are the specific profession trained and licensed to perform corrective spinal manipulation.
If an injury victim is unfortunate enough to have sustained fractures, lacerations or total tissue disruptions (such as a torn shoulder rotator cuff requiring a surgical repair), referral to an appropriate specialist will be made.
The answer, of course, depends on the specific case at hand. However, having said that, there are some common rules that apply. Any time a person intends to make a physical change in their body, the frequency of the activity producing that change is important. So, let's talk about some examples that most people understand, such as aerobic exercise or weight lifting. If a weight lifter, for example, is serious about making progress, how often will they lift weights? The answer is about every other day. And, it's pretty much the same for any other action wherein a physical change in the body is the intended outcome. So, if a significant extent of change (correction) is needed, a person should keep in mind what may be called a "therapeutic frequency" of treatment.
The next question is "How Long" is treatment required. That answer depends on many factors that will vary from patient to patient. How serious was the injury, the patients age and prior health or prior injuries, their occupation and work stresses, genetic predispositions and their ADL (activities of daily living) to cite a few examples. The initial intake patient history and examination reveal important findings that establish the injury diagnosis and also establish benchmarks for future comparison. Because of all these variable factors, treatment is made in stages. When significant injury has occurred, significant therapeutic intervention can be expected as well. The length of care needs to be of a sufficient duration to yield a measurable change. The precise duration will depend on the case at hand, however, an interval of approximately 30 days is considered a reasonable treatment interval in many cases.
So, is 30 days of treatment going to fix the problem? In most cases involving actual damage to muscle and ligament tissues, the short answer is: probably not. However, in order to continue treatment with any patient beyond the initial care schedule, a satisfactory extent of improvement needs to be evident. Patient status is determined by comparative examination and review of subjective symptoms and objective findings.
An important point of understanding here is that the presence or absence of pain, by itself, is not an accurate indicator of a patient's actual health status. Also, an important point of understanding is that, in cases involving significant injury, treatment for the duration of the healing time of the involved tissue is important to a favorable outcome. So, the question is... how long does a sprained muscle or ligament take to heal. Well, think about a broken bone. How long does that take? The answer is, approximately 8-12 weeks. And, since the healing time of soft tissue is somewhat similar to bone, many cases will wind up being under an active schedule of care for about 90 days. This, of course, will vary depending on the particular case at hand and this is one reason why periodic re-evaluation of the patient is important.
If you were not at fault in the accident, your auto insurance carrier can not drop you or raise your premium.
In that case the "uninsured motorist" coverage on your own auto policy will step in and act just like the other drivers insurance.
The use of Med Pay on your own policy will not raise your premium but will help you get a better settlement... Ask us how...
Your private information IS PRIVATE and will never be released without your written authorization and will never be breached by an online hacker because no patient data is stored on or exposed to the internet. All patient data is secured off line.
There may be home care activities to help speed you healing. Recommendations will be discussed by the doctor. Also, browse the Home Care Recommendations listed below.
Only you know how you feel and keeping a pulse on that is very important. So, let us know of any ups or downs in your progress.
Advise the doctor promptly if you experience any increased drowsiness, confusion, vomiting, increasing headache, fever, stiff neck, weakness in arms or legs, unequal pupil size or vision changes such as double vision.
During the first 48-72 hours following an acute injury - avoid applying heat. Especially be cautious of using an electric heating pad, due to the risk of burn. Ice packs should not be applied directly to the skin - use a thin towel between the cold pack and the area of application. Cold helps reduce swelling and inflammation and can be applied for 20 minutes on and 40 minutes off as needed for relief. After the first 72 hours following injury, heat applications of up to 15-20 minutes can be added to the home care regimen.
Neck and whiplash injury patient should limit the use of a cervical collar to no more than the first few days. Longer use can result in weakening / atrophy of the cervical muscles and
When sitting, a firm chair is best. Avoid soft / overstuffed type chairs or couches. When watching TV, sit - don't lie down - and be certain to sit facing straight toward the screen. Do not sit where you will have to hold your head in even a slightly turned position as this will worsen head and neck pains. Avoid bending the head forward, as in reading a book, for extended periods of time. When using your phone, do not cradle the phone by bending your head to the side against your shoulder. Try to avoid activities that require you to hold your arms above shoulder height for extended periods of time. Over-use of a vacuum sweeper can aggravate neck, shoulder, arm or back injuries, so be careful with this activity.
Follow a sensible diet based on good eating habits. Particularly, avoid food additives such as MSG (monosodum glutamate), artificial sweeteners such as nutrasweet and color additives such as red and yellow dyes in food. Experts agree that about 80% of your diet should be coming from the fruit and vegetable category (preferably raw or cooked until just tender). Steaming is better than boiling because it is faster and doesn't leach out vital nutrients like boiling does. Limit use of caffeine, sugar, colas and alcohol. If weight loss is a goal, limiting bread (grains), sugar and potatoes (starch) is really helpful.
In this practice we do not prescribe drugs of any kind, including over the counter medications. However, when something is needed for pain, patients commonly report satisfactory results with the available OTC such as Tylenol, Acetamenophen, or Ibuphrophen. One critically important advisory: never combine and of the OTC pain relievers with alcohol of any kind or in any amount. Potentially fatal liver damage is a concern.
Consider adding nutritional supplementation to your diet, especially vitamin C (3000-5000 mg/day) which is important to tissue healing. When muscle spasms are a problem, Magnesium may help. For the average adult about 500 mg / day may help. Loose stools is a sign to decrease the dosage. Also, supplements in capsules (not tablets) is suggested.
If you are a smoker, this is a good time to reduce or quit. Smoking slows the healing process by contaminating the blood stream with carbon monoxide, thus decreasing its oxygen carrying capacity and potency for healing. We are among those fearful that the habit of "vaping" will likely result in a future wave of respiratory failures. Our recommendation: don't do it.
A firm mattress is usually best. Avoid water beds. Use a medium to small pillow. Do not use more than one pillow under your head when sleeping on your back. Bunching your pillow under your neck or using a small rolled-up towel can help support the normal forward neck curve. Additional pillow placement may be used to achieve a position of comfort, such a pillow between the knees when sleeping on your side. DO NOT sleep on your stomach. Do not read or watch TV in bed. During your period of healing you will likely need more rest, so use your best efforts to get a full nights sleep... 8 hours is recommended.
One of the most important factors to enhanced healing is a "POSITIVE MENTAL ATTITUDE". While dealing with the pain, impairment, disruption and hardships caused by your injuries, remind yourself that "this too shall pass", and take advantage of every opportunity to make laughter a part of your day.
Dr. Carmichael puts your specific needs first. We are proud to provide a high quality level of professional service, chiropractic experience, and commitment to health and wellness to all our patients. Our goal is to improve your lifestyle by caring for your health.
With years of Auto Accident Rehab experience, Dr. Carmichael is capable of analyzing your body and creating a custom pain relief and rehabilitation plan to benefit your health. We understand the importance of educating you on chiropractic care so that you can heal quickly.
Not only will our auto accident rehab team treat your existing conditions, we strive to prevent pain and illness from reoccurring. We strive to help you improve your quality of life, achieve your wellness goals, and heal your body to live your best life possible.
With about 3 million whiplash injuries per year, (about 25% of all claims) it is reported that the estimated cost of auto accident related neck injuries is about 43 billion dollars per year... about the same as spent annually on diabetes. The total cost for ALL auto accidents is about 346 Billion per year... about the same as the cost of care for heart disease.
Many patients with chronic neck pain (about 46%) attribute the problem to a past auto accident and about 10-12% will become disabled. Problems that persist beyond the two year mark following an auto accident will likely not fully return to their pre-accident status.
When it comes to keeping you inside of the car... they're pretty good. But, when it comes to preventing injury... they're not so good. If fact, seat belts very often make neck and shoulder injuries WORSE. Why? Because, they anchor the upper part of your body and (especially in rear-end collisions) cause a more sudden / forceful whipping motion of the head and neck... thus, greater injury. Also, because in a front or rear collision the body is thrown against the shoulder strap, it is very common to see significant shoulder injuries... usually on the side of the strap. We see this on a regular basis. A driver will tend to have left shoulder injuries with the passenger (front seat) having right shoulder injuries.
Having said all of that, however, seat belts should still be used. Why? Because air bag deployment is a powerful explosive event and in a front impact of about 10 MPH or greater this event will likely occur. When that happens, the air bag will explode toward the occupants face at a speed of approximately 295 MPH and a pressure of about 2500 lb. per square inch. So, while the main purpose of the seat belt is to keep you INSIDE the car, another very important purpose is to keep you out of the "explosion zone".
Next... What about head rests? Well this is also an important feature, often overlooked. Top Set and Back Set are two important considerations. The head rest should be centered no lower than the center of the head (or top of the ears). The reason for this is that in a rear impact collision the occupant's torso will tend to "ride up" against the seat. If the head rest is positioned too low, the head will simply ride up over the headrest and increase the whipping motion in a "whiplash" injury, resulting in greater trauma to the occupant.
Back Set is a little the same way. There should be very little space between the back of the head and the head rest. Again, the reason is that if there is a large gap, the head rest offers no protection and in a rear-end collision the head snaps back and flies forward as if there was no head rest at all.
Dr. R. J. Shetlin, DC, in his interesting book Whiplash And Hidden Soft Tissue Injuries, points out that a 1989 study by the Cervical Spine Research Society of patients 7 years after whiplash revealed that 39% showed evidence of disc degeneration that was not previously evident. The expected incidence in the general population is 6%. This indicates that spinal injury, such as that caused by auto accidents, my cause spinal degenerative changes at a rate 6.5 times faster than that caused by normal aging. Since the nervous system controls everything in the body and is housed with the spine, premature degeneration of the spine can have a domino effect due to adverse effects on delicate nerve tissue and resulting adverse effects on various organ systems. Thus, if we have organ disease due to nerve involvement caused by spinal degeneration, we are actually aging prematuely. At 6.5 times the normal expected rate, we would be aging in "dog years".
Furthermore, the doctor adds that delay in proper treatment leads to adhesions about the facets and scarring about the capsular (joint) ligaments... Persistent spasm, congestive lymph edema, fibrosis of muscles, swelling and eventually adhesions of nerves wtihin the nerve root canals. A neglected case enhances the degeneration of the inter vertebral discs, and in addition, spur formation in the lateral co-vertebral articulations, which has come to be known as "traumatic arthritis". Degenerative changes take time to manifest and may stay hidden for years. And, by the time the patient realizes what has happened... the damage has already been done.
While the brain and spinal cord are housed and protected within a strong bony framework, they are still vulnerable to injury. For example, the brain is a soft tissue structure that essentially "floats" in a bath of CSF (cerebrospinal fluid) within the cranium and might be compared to a bowl full of jello and capable of being deformed. If the bowl is suddenly struck from one side, what will happen? The side of impact will experience a compressive force and the side opposite of impact will experience a decompression or separation from the containment vessel.
An auto accident that causes sudden powerful head movement, especially if there is any head strike (as in hitting the steering wheel, windshield or side window) can cause MTBI (Mild Traumatic Brain Injury), a potentially serious neurological injury. Signs of MTBI include any LOC (loss of consciousness), any loss of memory (pre or post MVA) or any altered mental state, such as being dazed, disoriented or confused.
Another, potentially far reaching consequence of traumatic brain injury can involve the pituitary gland. The pituitary gland is about the size of a small grape and located in the center of the brain, behind the eyes and between the ears. If a head strike is sufficiently forceful there may be injury to the pituitary. This gland produces several hormones that control such body functions as the body's kidney function / water balance, thyroid function, growth and metabolism, female ovulation, adrenal function and ability to respond to stress.
Part of the New Patient intake history and examination procedures screen for neurological injury, such as MTBI.
At Carmichael Auto Accident Rehab, patients never have to worry about confidential personal information being compromised or stolen by an on-line internet thief, hacker or ransomware scammer, because no patient's personal or private information is stored on line or exposed to the internet. All patient data is secured off line under lock and key.
Give us a call (417-886-4910) or Drop us an email: Carmichael.chiropractic@yahoo.com and let us know what's on your mind.
We like to include support of worthwhile charitable and non-profit organizations in our plans. We are pleased to have our giving back include the Greene County Humane Society, CARE (Castaway Animal Rescue Effort), the Pregnancy Care Center, Victory Mission, Drury University, Logan University, Hillsdale College, DAV, Gloria Deo Academy, Life Changers Community Outreach Center and The Salvation Army.
Dr. Carmichael and his team understand the stress and pain patients are in following personal injury accidents. Dr. Carmichael will analyze, diagnose, and create an individualized treatment plan for whiplash and soft tissue injuries. We will thoroughly explain your treatment and help you recover from your injuries and pain.
Most work injuries are caused by overuse and repetitive stress injuries. Over time, small tasks done with poor posture can lead to acute and chronic pain, which can result in reduced worker productivity, lost time from work, disability, and an inability to perform job tasks.